Unmet needs in patients with acute myeloid leukemia ineligible for intensive approaches: perspectives from a European expert panel

Acute myeloidleukemia(AML)isprimarilyadiseaseoftheelderly,withincreasing age associatedwithworseoutcomes.Treatmentoptionsincludeintensive chemotherapy,hypomethylatingagentswith/withoutvenetoclax,andbest supportive care.AlthoughthetreatmentlandscapeforAMLhasprogressedin recent years,survivalinolder,frailpatientsineligibleforintensivechemotherapy remains poor.Toaddressthis,apanelofEuropeanexpertsconvenedtodiscuss the keyfactorsinfluencing AMLprognosisinolderpatientsand/orthosedeemed unfit forintensivetherapy.ThepanelsharedperspectivesonAMLoutcomes, patient fitness,treatmentchoices,andunmetneeds.Expertsagreedthat although ageisanimportantfactoringuidingtherapeuticdecisionmaking, other factorsshouldalsobeconsideredsuchascomorbiditiesandtheimpactof disease biology(e.g.,cytogenetic/molecularaberrations).Expertsalsoagreed that morerobustassessmentsofpatient fitness arerequired,suchasthe utilization ofgeriatricassessmenttools.Aschoiceoftherapyanditsassociated toxicities canimpactpatient’s qualityoflife(QoL),thelogistical,psychosocial, and financial challengesexperiencedbythepatientandtheirsupportnetwork needs tobeconsideredwhendeterminingtreatment.Finally,expertsagreedthat outcomes inolder,unfit patientswithAMLremainsuboptimalinpartduetothe impact oftreatment-relatedtoxicitiesandQoLburden.Thereisthereforean urgentneedforalternativetreatmentswhichminimizetoxicityandreduce QoL burden.